Although the clinical outcome of heart transplantation in Japan is excellent in the past 11 years after establishment of the Organ Transplant Law, the total number of heart transplant is extremely limited in Japan, only 69 cases. The Law was revised and enforced in July 17, 2010, and pediatric heart transplantation is authorized in Japan from the legal point of view under the revised law. The most important revision of the law is that organs can be donated from brain death cadavers without written declaration of the donors themselves. We expect the number of the heart transplantation will be increased up to 30 to 50 cases per year, and social conditions are required also to be revised according to the revision of the Organ Transplant Law.